I support the idea that the federal government, as the major payer for healthcare services, can and should develop its own hospital quality ratings. CMS has now rated 3,617 hospitals with its new quality rating instrument and some of hospital executives are irked that they did not score well (see: Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings). The details were discussed in a recent article with an excerpt below:
The federal government [has] released its first overall hospital quality rating..., slapping average or below average scores on many of the nation’s best-known hospitals while awarding top scores to dozens of unheralded ones. The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality. Medicare does factor in the health of patients when comparing hospitals, though not as much as some hospitals would like. Just 102 hospitals received the top rating of five stars, and few are those considered as the nation’s best by private ratings sources such as U.S. News & World Report or viewed as the most elite within the medical profession. Medicare awarded five stars to relatively obscure hospitals and at least 40 hospitals that specialize in just a few types of surgery, such as knee replacements. There were more five-star hospitals in Lincoln, Neb., and La Jolla, Calif., than in New York City or Boston. Memorial Hermann Hospital System in Houston and Mayo Clinic in Rochester, Minn., were two of the nationally known hospitals getting five stars.
Five hospitals in Washington, D.C., received just one star, including George Washington University Hospital and MedStar Georgetown University Hospital, both of which teach medical residents. Nine hospitals in Brooklyn, four hospitals in Las Vegas and three hospitals in Miami received only one star. Some premier medical centers received the second highest rating of four stars, including Stanford Health Care in California, Duke University Hospital in Durham, N.C., New York-Presbyterian Hospital and NYU Langone Medical Center in Manhattan, the Cleveland Clinic in Ohio, and Penn Presbyterian Medical Center in Philadelphia. In total, 927 hospitals received four stars. Medicare gave its below average score of two-star ratings to 707 hospitals. They included the University of Virginia Medical Center in Charlottesville, Beth Israel Medical Center in Manhattan, North Shore University Hospital (now known as Northwell Health) in Manhasset, N.Y., Barnes-Jewish Hospital in St. Louis, Tufts Medical Center in Boston and MedStar Washington Hospital Center in D.C. Geisinger Medical Center in Danville, Pa., which is a favorite example for national health policy experts of a quality hospital, also received two stars.
It seems to me from this description of the results of the first round of CMS hospital quality ratings that they were somewhat skewed. The five star rating, the highest, was awarded to hospitals that were not "considered as the nation’s best by private ratings sources such as U.S. News & World Report or viewed as the most elite within the medical profession." However, four stars were awarded to Stanford Health Care, Duke University Hospital, New York-Presbyterian Hospital, NYU Langone Medical Center, Cleveland Clinic, and Penn Presbyterian Medical Center. Perhaps the low ratings for well-known institutions such as Northwell Health and Geisinger Medical Center were a combination of a partly flawed rating system and also the lack of attention by the downgraded hospitals to the factors addressed by the CMS instrument.
I suspect that CMS will not back off from their goal of rating U.S. hospitals. For the next round of assessments, two things will probably happen. Firstly, CMS will take some pains to improve their evaluation instrument to ensure that there is no bias against the large hospitals which care for more complex and sicker patients. At the same time, however, well-known hospitals that did not rank well need to try to understand how to improve their rankings. Meanwhile, I would predict that few patients who would ordinarily seek their care at, say, Barnes-Jewish or Geisinger will shift their loyalty to other facilities on the basis of this CMS survey about which they would probably have little knowledge.